Internet-Based Cognitive Behavioural Therapy (iCBT): A Game Changer for Mental Health

The term internet-based cognitive behavioural therapy (iCBT) already existed long before the term digital therapeutics began to establish itself for digital psychotherapeutic treatment programmes. In fact, the first research studies on iCBT-treatments were carried out in the late 1990s. Since then, several hundred studies and randomised controlled trials have been published. The promising results often indicated that iCBT is clinically effective when compared to control groups. Intensive research in this field proved that iCBT programmes can deliver effective evidence-based therapeutic interventions to patients in need.

Given the enormous challenges that traditional mental healthcare is facing globally, internet-based cognitive behavioural therapy thus appears to be a viable instrument to help close the gaps in the existing care system.

Treating mental health disorders

To manage depression and other mental health disorders, pharmacological (medication) and nonpharmacological (psychotherapy) interventions are the most prevalent methods that currently constitute the standard of care. Antidepressants are a common and cost-efficient treatment but the clinical efficacy can be impacted by poor patient compliance to the medication regimens. This is an issue especially when the medication intake leads to side effects (such as weight gain) or does not impact the patient right away as the drug level in the blood needs to be built up over several weeks to experience a measurable impact on depressive symptoms.

Saptarshi Purkayastha et al. outlined in their research about digital cognitive behavioural therapy that existing evidence suggests that cognitive behavioural therapy (CBT), on its own, is as effective as antidepressant medications for depression.

In addition, supplementing pharmacological interventions with CBT might be the most effective combination treatment for the management of major depression in most patients. Moreover, early research suggests that psychoactive compounds such as MDMA and psilocybin can have a profound impact on patients suffering from treatment-resistant depression or PTSD.

Why are digital interventions like iCBT needed in mental health?

Usually, a therapist delivers cognitive behavioural therapy during in-person therapeutic meetings. During these recurring sessions, the therapist assesses the client’s past and current psychological status using validated diagnostic instruments, basically short questionnaires, to determine the level of symptom severity. Studies have shown that CBT can provide long-term protection against relapsing into depression. Nevertheless, the efficacy is highly dependent on the skills of the therapist who delivers the CBT, creating a problematic bottleneck.

First, the CBT training of therapists is expensive and can take two to six years of additional training. Clearly, there are many instances where highly trained professionals are needed, to deliver high-quality services in many healthcare settings. However, if a healthcare system fails to provide for future demand growth (which can not always be anticipated due to unforeseen events such as COVID-19), the training time needed to create additional capacity means that the system cannot flexibly react to demand shocks. Demand will exceed the existing supply for quite some time.

Second, the lack of resources to provide such training and the lack of availability of trained professionals are the most critical limiting factors restricting the widespread uptake of CBT. 

Last, cognitive behavioural therapy is a service provided by individual therapists. Due to the significance of the human touch in medicine, healthcare struggles to benefit from the digital transformation which has already led to increased efficiency and cost reduction in most industries. On the contrary, one of the biggest healthcare challenges are health expenditures that increased substantially over the past several decades in the US and other countries.

In countries, such as Germany, there are plenty of trained therapists but the limited budgets constrain supply. In our last blog article on healthcare innovations, we explained this cost “disease” and potential cure that could help to address it: delivering healthcare services in form of a digital product that can be manufactured, commoditised, industrialised, distributed and automated. This approach significantly lowers the cost of delivery and provides more people access to mental healthcare.

iCBT complements and enhances existing mental health care structures

Internet-based cognitive behavioural therapy can provide safe/low-risk, effective, scalable and efficient support for people with mental health disorders. At HelloBetter, we have shown in over 30 randomised controlled trials (the ‘gold standard’ trial for evaluating the effectiveness of interventions) that iCBT complements and enhances existing mental health care offerings.

Here is a list of some of our randomised controlled trials:

Depression:

• Effectiveness of a Guided Web-Based Intervention to Reduce Depressive Symptoms before Outpatient Psychotherapy: A Pragmatic Randomized Controlled Trial (2021)


• The more I got, the less I need? Efficacy of Internet-based guided self-help compared to online psychoeducation for Major Depressive Disorder (2019)

Sleep:

• Efficacy of a self-help web-based recovery training improving sleep in workers: results of a randomized controlled trial in universal prevention (2020)

Panic and Agoraphobia:

• Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial (2021)

Alcohol:

• Efficacy of a web‐based intervention with and without guidance for employees with risky drinking: results of a three‐arm randomized controlled trial (2017)

Diabetes and Depression:

• The 6‐month effectiveness of Internet‐based guided self‐help for depression in adults with Type 1 and 2 diabetes mellitus (2017)

Overall, the research landscape and the evidence collected underline the effectiveness of iCBT and the potential to improve mental healthcare. 

The future of care delivery will inevitably combine in-person, virtual and digital care experiences. As digital therapeutics and iCBT provide a digital always-on option for care delivery, they will play a key role in every healthcare system.

In our next Insights articles, we will show you the capabilities of HelloBetter’s digital therapeutics and their integration into the ‘standard of care’ in Germany.

About HelloBetter

HelloBetter is a global pioneer in the field of digital mental health. No other provider worldwide has conducted as many clinical studies on the effectiveness of its online mental health courses. With our unrivalled scientific expertise (30+ RCTs) and passion for supporting people with mental health problems, we have already helped tens of thousands of patients to lead better lives. Find out more about HelloBetter on our Company page.

With HelloBetter Insights we want to share our learnings and analysis with the broader mental healthcare community. Every week, we will survey the ecosystem, report on promising developments, but also highlight the tough challenges that the industry is facing.